There are many effective treatment options for ED. This condition can be successfully reversed in more than 19 out of 20 men. Which treatment options work best may depend on ED’s underlying causes, as well as your own needs and preferences.

Addressing Common Causes of ED

Erectile dysfunction is often caused by changes to your hormones, vascular system (heart and blood vessels), nervous system, or mental health. If you are experiencing ED, your doctor may want to perform a general health check-up to see whether it might be caused by another factor, such as an underlying health condition or medication.

Disorders That Could Cause ED

When ED occurs, it could be a sign that something else is going on with your health. For example, one common cause of ED is diabetes. Men with diabetes are three times more likely to develop erectile dysfunction, compared to men without diabetes. If you experience ED along with other diabetes symptoms, such as frequent urination, extreme thirst or hunger, or unexpected weight loss, tell your doctor. Diabetes can be managed with proper diet, exercise, or medication.

Erectile dysfunction may also be caused by:

• Hypertension (high blood pressure)
• Heart disease
• Atherosclerosis (a condition in which plaque builds up in the arteries, hardening them and blocking blood flow)
• Kidney disease
• Peyronie’s disease
• Multiple sclerosis (MS)
• Parkinson’s disease
• Damage to the penis, prostate, bladder, or spinal cord

ED can also develop after certain cancer treatments. Surgery for prostate cancer or bladder cancer can cause the condition. Additionally, other prostate cancer treatments such as radiation therapy to the pelvis and androgen suppression therapy may lead to ED.

Treating an underlying disorder may help improve ED symptoms. It’s important to talk to your doctor if you start experiencing this condition.

Mental Health and ED

Some mental disorders or emotional factors can cause erectile dysfunction or make it worse. ED can be a symptom of both anxiety and depression. Feelings of guilt, fear, or low self-esteem surrounding your sexual performance can also cause ED. Finally, men are more likely to experience ED when they are stressed or tired.

Talking to a counselor, therapist, or another mental health professional can help with all of these issues. These health providers can teach you techniques to better manage stress, reduce anxiety or depression symptoms, or reframe your attitudes surrounding sex. For some men, counseling is the most effective ED treatment.

ED as a Medication Side Effect

Medications that can lead to ED include:

• Medications to treat high blood pressure
• Antidepressants
• Antianxiety medications that slow down processes in the brain and body, such as tranquilizers or sedatives
• Antihistamines
• Ulcer medications
• Medications that suppress appetite

If you develop ED after trying a new drug or switching medication doses, talk to your doctor. You may be able to try an alternative treatment plan that won’t cause this side effect. However, it’s important to not stop taking a drug without first talking to your doctor, as some medications shouldn’t be stopped abruptly.

Lifestyle Changes

Your daily habits and choices can sometimes create or exacerbate problems with ED. Making some or all of the following changes may help:

• Quit smoking with the aid of nicotine products, prescription medications, or support programs
• Reduce the amount of alcohol you consume, or quit drinking altogether
• Stop using illicit drugs with the help of your doctor, a therapist, or an addiction treatment program
• Get more physical activity throughout the day by going on a walk, doing some work around the house, or trying aerobic exercise or a strength training workout
• Achieve and maintain a healthy weight

Oral Medications for ED

There are several drug options that can help treat ED. They include:

• Viagra (sildenafil)
• Cialis (tadalafil)
• Levitra (vardenafil)
• Stendra (avanafil)

These medications enhance natural processes in the body that cause erections. A chemical called nitric oxide is partially responsible for erections. It relaxes muscles within the penis and widens blood vessels, boosting blood flow.

Oral (taken by mouth) ED medications strengthen nitric oxide’s natural effects. They can make it easier for you to experience erection when you are sexually aroused.

Safety of Oral ED Medications

Sildenafil, tadalafil, vardenafil, and avanafil are generally safe to take for most men. However, men with certain conditions should avoid these medications. These drugs may not be safe if you:

• Have heart disease
• Have experienced a stroke
• Have been diagnosed with very low or high blood pressure
• Have diabetes that is not controlled with diet or medication
• Have severe liver or kidney disease
• Take nitrates (medications to treat heart conditions) such as Nitrostat (nitroglycerin) or Imdur (isosorbide mononitrate)
• Use anticoagulants (medications that help thin the blood), including Coumadin (warfarin), Pradaxa (dabigatran), or Xarelto (rivaroxaban)
• Take medications for high blood pressure or prostate enlargement, including alpha blockers like Cardura (doxazosin) or Minipress (prazosin)

Oral ED medications often don’t cause any major side effects. However, some men may experience certain health changes while using these drugs, including:

• Headache
• Stuffy nose
• Flushed skin on the face, neck, or chest
• Upset stomach
• Blurry or blue-tinged vision
• Back pain

If you are interested in using oral ED medications, ask your doctor about possible positive and negative effects. Your doctor can also help you understand whether you can take these medications safely based on your personal health history.

Which Medication Is Best?

Each of these ED medications may lead to slightly different side effects and last for different lengths of time. For example, sildenafil and vardenafil typically last four to five hours, avanafil’s effects continue for up to six hours, and tadalafil can last for 36 hours.

Doctors often first recommend sildenafil for erectile dysfunction because this drug was developed first and it has been studied the longest. However, you may find that you prefer a different medication based on its effects or financial costs. You may need to try more than one medication or adjust your medication dose before you find something that works well for you.

Testosterone Replacement Therapy

Testosterone is a sex hormone that plays a role in sexual development and fertility, and sexual function, including erections. The amount of testosterone in the body decreases with age, and can also drop due to changes in the brain, problems with the thyroid (a gland that makes hormones), testicular damage, or obesity. Low levels of testosterone are sometimes responsible for ED.

Low testosterone levels could also cause symptoms like:

• Low sex drive
• Sleeping problems
• Low sperm count
• Weight gain
• Decreased muscle strength
• Weaker bones
• Psychological problems like depression or difficulties focusing

If your ED is caused by low testosterone levels, you may be able to try testosterone replacement therapy (TRT). This involves taking medications that contain laboratory-made testosterone in order to elevate hormone levels in the body. This medication may come in the form of a pill, patch, implant, patch, or injection.

TRT may come with some side effects, such as:

• Infertility
• Insomnia
• Problems with urination
• High cholesterol levels
• Heart problems
• Blood clots

TRT may interact with certain medications, and only works if ED is caused by certain factors, so talk to your doctor before trying this therapy.

Other Erectile Dysfunction Medications

A couple of other medication options besides pills may also help with ED. One option is Caverject (alprostadil), a drug that is injected into the penis. This medication encourages blood to flow into the penis, making it become erect. The injection usually leads to an erection within five to 20 minutes, and the erection typically lasts between 30 and 60 minutes.

Alprostadil can also be used as a urethral suppository — a small pellet placed into the opening of the penis with an applicator. This form of alprostadil generally causes an erection within 10 minutes and its effects also last 30 to 60 minutes.

Alprostadil can lead to side effects like bleeding or bruising at the injection site, pain or burning in the penis or surrounding tissues, headache, back pain, or vision changes. Before using alprostadil injections or suppositories, tell your doctor if you are taking blood-thinning medications or using drugs to treat high blood pressure, allergies, or a cold.

Medical Devices for Erectile Dysfunction

Another possible ED treatment is a vacuum device or penis pump. To use this device, you place a plastic tube around your penis and use a pump to draw air out, which causes more blood to flow into the area. After achieving an erection, you place a ring around the base of your penis to keep your blood, and your erection, in place.

Vacuum devices may cause bruising, or make your penis feel cold or numb. However, most men experience orgasm normally after using this device.

Surgical Procedures for ED

The above treatment options will work for most men. However, in some cases a man may choose to try surgical ED treatments.

In one type of surgery, a doctor can implant a device into the penis. This may be an inflatable device connected to a pump in the scrotum, or a flexible rod that allows a man to move his penis into the desired position.

Some cases of ED are caused by a blocked blood vessel that prevents blood from reaching the penis. In this case, the blood vessel may be able to be fixed with surgery.

Alternative Medications and Supplements

Companies make many “natural” medicines or supplements that they say can treat ED. Some of these products may help improve sexual function, while many come with some risks.

Some studies have identified natural herbs or supplements that could possibly help ED and appear to be safe when taken at recommended doses. These include:

• L-arginine
• Ginseng
• Dehydroepiandrosterone (DHEA)
• Propionyl-L-carnitine

Although these supplements are often labeled as “natural” and are available without a prescription, you should still tell your doctor if you choose to use them. Some of these herbs, like ginseng, are only known to be safe when men use them for the short term. Other supplements, like L-arginine, shouldn’t be combined with other ED medications like sildenafil.

Not all supplements are safe. The U.S. Food and Drug Administration (FDA) has identified hundreds of supplements that contain drug ingredients not listed on the label. These supplements can sometimes cause serious health problems.

Some online retailers also claim to sell “herbal” versions of common prescription ED medications. These supplements are often not legitimate and can contain harmful substances.

In order to minimize risks, only take medications that are recommended by your doctor. It’s also a good idea to avoid products that claim to work very fast, are sold as single doses or were advertised to you through unsolicited emails.

Buying Medications Online

There are many places online where you can buy ED treatments — both supplements and prescription medications. Unfortunately, many retailers run scams or sell counterfeit treatments.

Keep yourself safe by only buying treatments from reputable pharmacies, whether online or brick-and-mortar. Some good rules to follow include:

• Avoid buying prescription medications from places that claim a prescription is not necessary.
• Only purchase medications from online pharmacies that list a valid phone number for contact purposes and ask to speak with licensed pharmacist to ensure there is proper medication counseling available.
• If the online pharmacy is outside the United States, ensure it is certified by Canadian International Pharmacy Association (CIPA) by clicking on its CIPA seal.
• When you receive your medication in the mail, make sure that it contains the right drug and dose.

Which ED Treatment Is Best?

The therapy that is most effective for someone else may not be the one that is best for you. The ideal ED treatment plan depends on factors like what is causing your condition, how severe your ED is, and whether you have other health conditions that contribute to your ED.

Your doctor can help you understand which treatment might be best for you and the benefits and drawbacks of each option. They can also prescribe any medications that you may need. It can be pretty tough to bring up this topic with your doctor but initiating that conversation can be the key to curing your ED and improving your well-being. If you or your loved one is experiencing ED and you would like to discuss it with a doctor, please make an appointment with Dr. Connor.